Experts cite access to contraception as key

Nurse Sherry Hefner talks to a female student in an exam room in the Health Clinic at Roosevelt High School in Los Angeles, where students can get free condoms and get checked for sexually transmitted disease . Bob Owen/San Antonio Express-News

Nurse Sherry Hefner talks to a female student in an exam room in the Health Clinic at Roosevelt High School in Los Angeles, where students can get free condoms and get checked for sexually transmitted disease .

Sherry Hefner-Medrano, Nurse at the Health Clinic at Roosevelt High School in Los Angeles, hands out condoms to a male student in her office. Students can get free condoms and get checked for sexually transmitted disease at the clinic. Bob Owen/San Antonio Express-News

The 17-year-old receives her contraception free and without parental consent at her school, a service offered in health clinics at high schools — and many middle schools — in high-poverty districts in California.

The confidential part is key: “My parents don't know and I don't want them to know,” she said.

Without the clinic at Roosevelt High School, she couldn't afford the pills, and she lacks a car to go off-campus. Having a baby is just not part of her plan to snag an athletic scholarship and earn a bachelor's degree in psychology.

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About two decades ago, California, like Texas, had a soaring number of teens having babies.

Since then, it has dramatically reduced that number, while Texas — which ranked fourth in the nation for the most teen births in 2010 — remains mired in the problem.

One key reason for California's success is giving teens more access to contraception, experts say. Parental consent is not required.

At many of the 183 school clinics in low-income neighborhoods in the state — most are in areas of Los Angeles, San Francisco and San Diego — reproductive care is free and confidential, a practice that began 20 years ago but was expanded in recent times.

California also provides family planning to some teens through Medicaid, as does Texas through certain Medicaid managed-care programs, but those numbers aren't tracked, officials said.

However, the major player in the California decline was Family PACT, a mostly federally funded program the state launched in 1997 that provides free contraception as well as other reproductive care to minors. Teens use their own income to qualify, so virtually no one is turned away.

California spent $102 million on teen reproductive services through Family PACT in 2010 alone, serving more than 125,000 teens 17 and under.

By comparison, Texas served about 49,000 low-income teens with about

$10 million in family planning and reproductive care through either regular Medicaid or funding through the Texas Department of State Health Services.

An additional 13,500 teens ages 18 and 19 received services through the Texas Medicaid Women's Health Program, a special Medicaid plan that has become embroiled in a political fight over whether Planned Parenthood should be able to participate.

The coffers got lighter in Texas with the most recent legislative session, when conservative lawmakers cut

$73 million from family planning in a stated effort to starve Planned Parenthood, which by law can't use government money to fund abortions.

“The goal was to stop the money for killing babies,” said Rep. Wayne Christian, who asserted other health care entities will take up the slack as Planned Parenthood is pushed out.

But José E. Camacho, executive director of the Texas Association of Community Health Centers, said that's not happening.

“Our budgets have been decimated,” he said.

Women's health advocates worry the reduction in services will hurt women, including teenagers.

The cuts forced University Health System, which saw its family planning budget slashed from $1.9 million to $600,000, to reduce the availability of services from nine clinics to four. Spokeswoman Leni Kirkman said 900 teens were served in 2011.

The cuts “could result in a decrease in the number of teens seen,” as well as other women, she said.

In contrast to its current two-year family planning budget, $37.9 million, Texas will spend $3 billion on its penal system in 2012 alone.

Apart from money spent on reproductive care, the two states differ in their laws.

Consent or not

In California, all minors can legally obtain contraception without parental consent.

In Texas, teens under 18 must have consent to get birth control unless they belong to the military or are living apart from parents or caregivers and managing their own finances. This includes teens paying with cash or using their parents' insurance.

The law creates seemingly absurd scenarios: A 16-year-old mother in Texas can consent to medical care for her baby but not to her own contraception without parental consent.

An exception is teens who seek birth control at clinics such as University Health System's that use federal funds — the number of which was reduced from 300 to 143 statewide because of the cuts.

“There is lots of evidence that teens will not seek care (at clinics) or ask questions if not assured of confidentiality,” said Dr. Janet Realini, president of Healthy Futures Texas, a nonprofit organization that seeks to prevent teen and unplanned pregnancy.

Many teens won't use neighborhood clinics for fear they'll be seen by relatives or neighbors, the impetus behind California's school-based clinics.

In Texas, only a handful of school clinics in Houston — part of a Baylor College of Medicine program — offer contraceptive care, with parental permission. Two are located in high schools. Five are linked to clinics in the neighborhood.

Tracking shows the on-campus clinics are more effective in reducing the number of teen pregnancies and repeat teen pregnancies than the neighborhood clinics, said Peggy Smith, who oversees the program.

Smith said no other school districts in Texas have asked her for information on how to start such a program.

“One issue may be funding,” she said.

Cuts to family planning have made it harder for clinics to stock expensive, long-acting birth control such as implants — favored by teens, who can be inconsistent pill takers and condom users. Experts fear this may cause an uptick in abortions.

“Studies show 40 percent of women (of all ages) who lose access to birth control and become pregnant decide to abort,” said Fran Hagerty, chief executive officer of Women's Health and Family Planning Association of Texas.

California teens have more abortions than Texas teens. The state pays for abortions for low-income women and teens and has no parental notification laws. Still, California reduced its abortion rate by 66 percent at the same time it brought down teen births and pregnancies.

Free condoms﻿

On the recent afternoon in the clinic at Roosevelt High in Los Angeles, which has 3,000 students, a 16-year-old sauntered in and grabbed a handful of condoms from a large bowl.

“Got to protect yourself,” he said, jamming them in his pocket with a grin.

In Texas, no law bars schools from handing out free condoms on campus, but none do — at least those in major cities. Likewise, no law bars school clinics from providing contraception with parental consent, but none do besides the Houston clinics.

In California, free condom give-away programs are common, indeed required at some high schools — a practice endorsed by the American Academy of Pediatrics.

Nurse practitioner Sherry Hefner-Medrano said her clinic at Roosevelt High couldn't dispense contraception during the spring of 2008 for lack of funding. In that time, 32 teens tested positive for pregnancy.

After partnering with Planned Parenthood in 2009, the number in that same time frame dropped to three. It has since inched up to 10.

“That's still a big improvement,” she said.

Through the years, only a few parents have stormed into her clinic with condoms or pill packets in their hands. She tells them she can't confirm if she's treated their child, it's confidential, but she does walk them through the reasons they should be glad if their kid is taking responsibility: Sexually transmitted disease. Pregnancy. Dropping out. Even death.

“And then they ask me, ‘What should I do with this?' I tell them, ‘Put it back where you found it.' And they do.”